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The 30-Day Readmission Rate of Same-Day Discharge Following Transcatheter Aortic Valve Implantation (from National Readmission Database 2015 to 2019). Am J Cardiol 2022; 176:112-117. [PMID: 35644697 DOI: 10.1016/j.amjcard.2022.04.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 11/20/2022]
Abstract
The length of hospital stay after transcatheter aortic valve implantation (TAVI) has decreased over the years, and next-day discharge is being increasingly adopted in clinical practice. Whether further expediting discharge after TAVI by allowing same-day discharge (SDD) in selected patients is safe or derives additional benefits remains unanswered. Using the United States Nationwide Readmission Database 2015 to 2019, we identified 196,618 patients who received TAVI (mean age 79.5 8.4 years, 45.0% female). Of these, 245 patients (0.12%) were discharged on the same day they received TAVI (SDD group), and the remaining 196,373 were discharged on a different day (different-day discharge [DDD] group). A propensity score-matched analysis was done. The rate of unplanned readmission within 30 days of discharge was not significantly different between the SDD and DDD groups (11.0% vs 10.6%, hazard ratio 1.03, 95% confidence interval 0.56 to 1.90, p = 0.921). Hospitalization costs were significantly lower in the SDD group than the DDD group ($37,811 ± 18,029 vs $49,130 ± 27,007, p <0.001). In conclusion, the 30-day readmission rate was similar for patients discharged on the same day after TAVI and for patients discharged at a later time point.
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Asbeutah AA, Junaid M, Hassan F, Avila Vega J, Efeovbokhan N, Khouzam RN, Ibebuogu UN. Same day discharge after structural heart disease interventions in the era of the coronavirus-19 pandemic and beyond. World J Cardiol 2022; 14:271-281. [PMID: 35702323 PMCID: PMC9157608 DOI: 10.4330/wjc.v14.i5.271] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/14/2022] [Accepted: 04/21/2022] [Indexed: 02/06/2023] Open
Abstract
With recent advancements in imaging modalities and techniques and increased recognition of the long-term impact of several structural heart disease interventions, the number of procedures has significantly increased. With the increase in procedures, also comes an increase in cost. In view of this, efficient and cost-effective methods to facilitate and manage structural heart disease interventions are a necessity. Same-day discharge (SDD) after invasive cardiac procedures improves resource utilization and patient satisfaction. SDD in appropriately selected patients has become the standard of care for some invasive cardiac procedures such as percutaneous coronary interventions. This is not the case for the majority of structural heart procedures. With the coronavirus disease 2019 pandemic, safely reducing the duration of time spent within the hospital to prevent unnecessary exposure to pathogens has become a priority. In light of this, it is prudent to assess the feasibility of SDD in several structural heart procedures. In this review we highlight the feasibility of SDD in a carefully selected population, by reviewing and summarizing studies on SDD among patients undergoing left atrial appendage occlusion, patent foramen ovale/atrial septal defect closure, Mitra-clip, and trans-catheter aortic valve replacement procedures.
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Affiliation(s)
- Abdulaziz A Asbeutah
- Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38013, United States
| | - Muhammad Junaid
- Internal Medicine, Forrest City Medical Center, Forrest City, AR 72335, United States
| | - Fatima Hassan
- Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38013, United States
| | - Jesus Avila Vega
- Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38013, United States
| | | | - Rami N Khouzam
- Department of Medicine, The University of Tennessee Health Science Center, Memphis, TN 38104, United States
| | - Uzoma N Ibebuogu
- Department of Cardiology, University of Tennessee Health Science Center, Memphis, TN 38103, United States
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Krishnaswamy A, Isogai T, Agrawal A, Shekhar S, Puri R, Reed GW, Yun JJ, Unai S, Burns DJP, Vargo PR, Kapadia SR. Feasibility and Safety of Same-Day Discharge Following Transfemoral Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2022; 15:575-589. [PMID: 35331449 DOI: 10.1016/j.jcin.2022.01.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVES This study evaluated the feasibility and safety of same-day discharge (SDD) following transfemoral transcatheter aortic valve replacement (TF-TAVR) compared with next-day discharge (NDD). BACKGROUND Reducing hospital length of stay is an important goal for patients and hospitals. Cleveland Clinic implemented a post-TAVR SDD pathway beginning in March 2020. METHODS The study retrospectively analyzed patients who underwent "minimalist" outpatient TF-TAVR in 2019 to 2020. SDD was applied to patients who met the predefined criteria. Outcomes included in-hospital and 30-day events and were compared between SDD and NDD (during and prior to availability of the SDD pathway). RESULTS In 2020, SDD and NDD accounted for 22.1% (n = 114 of 516) and 63.8% (n = 329 of 516) of outpatient TF-TAVR, respectively. SDD patients in 2020, compared with NDD patients in 2019 (n = 481), were younger, were more often male, and had a lower surgical risk. There were no significant differences in in-hospital events and 30-day readmissions (cardiovascular readmission: 3.5% vs 6.2%; P = 0.37; noncardiovascular readmission: 2.6% vs 4.0%; P = 0.78), and there were no deaths after SDD. These outcomes remained consistent after propensity score matching. Only 1 (0.9%) patient required pacemaker implantation after SDD (post-TAVR day 25). As expected based on SDD criteria, multivariable logistic regression analysis identified procedure end-time as the strongest predictor of SDD (adjusted OR: 7.74; 95% CI: 4.39-13.63), while male sex and baseline hemoglobin level were also associated with SDD. CONCLUSIONS SDD after TF-TAVR was feasible in this early experience without impairing post-discharge safety. Our SDD pathway may serve as a useful strategy to improve bed utilization and reduce hospital stay for TAVR recipients.
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Affiliation(s)
- Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/toshiaki_isogai
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/AnkitAgrawalMD
| | - Shashank Shekhar
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/brownshekhar
| | - Rishi Puri
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Grant W Reed
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/GrantReedMD
| | - James J Yun
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shinya Unai
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Daniel J P Burns
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick R Vargo
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA. https://twitter.com/tavrkapadia
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Barker M, Sathananthan J, Perdoncin E, Devireddy C, Keegan P, Grubb K, Pop AM, Depta JP, Rai D, Abtahian F, Spence MS, Mailey J, Muir DF, Russo MJ, Pineda-Salazar J, Okoh A, Smith M, Dahle TG, Rana M, Alfadhel M, Meier D, Chatfield A, Akodad M, Chuang A, Samuel R, Nestelberger T, McAlister C, Lauck S, Webb JG, Wood DA. Same-Day Discharge Post-Transcatheter Aortic Valve Replacement During the COVID-19 Pandemic: The Multicenter PROTECT TAVR Study. JACC Cardiovasc Interv 2022; 15:590-598. [PMID: 35331450 PMCID: PMC8936029 DOI: 10.1016/j.jcin.2021.12.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 12/23/2022]
Abstract
Objectives The aim of this study was to determine the safety and efficacy of same-day discharge (SDD) after transcatheter aortic valve replacement (TAVR) during the COVID-19 pandemic. Background The COVID-19 pandemic has placed significant stress on health care systems worldwide. SDD in highly selected TAVR patients can facilitate the provision of essential cardiovascular care while managing competing COVID-19 resource demands. Methods Patient selection for SDD was at the discretion of the local multidisciplinary heart team, across 7 international sites. The primary outcome was a composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new permanent pacemaker (PPM) implantation. Results From March 2020 to August 2021, 124 of 2,100 patients who underwent elective transfemoral TAVR were selected for SDD. The average age was 78.9 ± 7.8 years, the median Society of Thoracic Surgeons score was 2.4 (IQR: 1.4-4.2), and 32.3% (n = 40) had preexisting PPMs. There were no major vascular complications, strokes, or deaths during the index admission. One patient (0.8%) required PPM implantation for complete heart block and was discharged the same day. No patient required a PPM between discharge home and 30-day follow-up. The composite of cardiovascular death, stroke, myocardial infarction, all-cause readmission, major vascular complications, and new PPM at 30 days occurred in 5.7% patients (n = 6 of 106). Conclusions SDD post-TAVR is safe and feasible in selected patients at low risk for adverse clinical events postdischarge. This strategy may have a potential role in highly selected patients even when the COVID-19 pandemic abates.
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Affiliation(s)
- Madeleine Barker
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janarthanan Sathananthan
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Perdoncin
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Chandan Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Patricia Keegan
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Kendra Grubb
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Andrei M Pop
- AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Jeremiah P Depta
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, Rochester, New York, USA
| | - Farhad Abtahian
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, New York, USA
| | - Mark S Spence
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Jonathan Mailey
- Department of Cardiology, Royal Victoria Hospital, Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - Douglas F Muir
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, United Kingdom
| | - Mark J Russo
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jennifer Pineda-Salazar
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Alexis Okoh
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Meghan Smith
- Division of Cardiac Surgery, Department of Surgery, Rutgers Roger Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Thom G Dahle
- Department of Cardiology, CentraCare Heart and Vascular Center, St. Cloud, Minnesota, USA
| | - Masud Rana
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mesfer Alfadhel
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Meier
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Chatfield
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mariama Akodad
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Chuang
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rohit Samuel
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas Nestelberger
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cameron McAlister
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandra Lauck
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular Innovation-Centre d'Innovation Cardiovasculaire, St. Paul's and Vancouver General Hospitals, University of British Columbia, Vancouver, British Columbia, Canada.
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Pop AM, Barker M, Hickman L, Barrow F, Sathananthan J, Stansfield W, Nikolov M, Mohamed E, Lauck S, Wang J, Webb JG, Wood DA. Same Day Discharge during the COVID-19 Pandemic in Highly Selected Transcatheter Aortic Valve Replacement Patients. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2021; 5:596-604. [PMID: 35340994 PMCID: PMC8935931 DOI: 10.1080/24748706.2021.1988780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 12/19/2022]
Abstract
Background Transcatheter aortic valve replacement (TAVR) with a standardized clinical pathway allows most patients to achieve safe next-day discharge. This approach has been successfully implemented across global centers as part of the Benchmark Program. Considering restricted hospital resources resulting from the COVID-19 pandemic, a modified same day discharge (SDD) clinical pathway was implemented for selected TAVR patients at a single Benchmark site. Methods All patients accepted for TAVR were assessed for the SDD clinical pathway. Eligibility criteria included adequate social support and accessibility to the TAVR program post-discharge. Patients with preexisting conduction disease were excluded. The clinical pathway comprised of mobilization, bloodwork and electrocardiogram 4 hours post-TAVR and discharge ≥8 hours following groin hemostasis. Results From June to December 2020, 142 patients underwent TAVR at a single community Benchmark site. Of those, 29 highly selected patients were successfully discharged the same day using the SDD clinical pathway. There were no vascular access complications, permanent pacemaker (PPM) implantation, or mortality in the SDD group during index admission or at 30-day follow-up. When compared to a standard therapy group, there was no statistically significant difference in 30-day cardiovascular readmission. Conclusions This study demonstrates the safety and feasibility of same day discharge post-TAVR in a highly selected cohort of patients, with no observable difference in safety outcomes when compared to patients who were discharged according to standard institutional practice.Abbreviations: AS: aortic stenosis; ACT: Activated clotting time; AV: atrioventricular; AVB: atrioventricular block; BBB: bundle branch block; CAIC: Canadian Society for Cardiovascular Angiography; CCL: cardiac catheterization laboratory; CT: Computed topography; CV: cardiovascular; IQR: Interquartile Range; IVCD: intraventricular conduction delay; LBBB: left bundle branch block; LOS: length of stay; NDD: next day discharge; PPM: permanent pacemaker; RBBB: right bundle branch block; SCAI: Society for Cardiovascular Angiography and Intervention; SD: standard deviation; SDD: same day discharge; ST: standard therapy; STS PROM: society of thoracic surgeons predicted risk of mortality; TAVR: transcatheter aortic valve replacement; TF: transfemoral; THV: transcatheter heart valve; TTE: transthoracic echocardiogram; VARC: Valve Academic Research Consortium
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Affiliation(s)
- Andrei M Pop
- Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Madeleine Barker
- Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn Hickman
- Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Firas Barrow
- Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Janarthanan Sathananthan
- Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - William Stansfield
- Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Michael Nikolov
- Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Elsayed Mohamed
- Department of Cardiology, AMITA Alexian Brothers Medical Center, Elk Grove Village, Illinois, USA
| | - Sandra Lauck
- Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jia Wang
- Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A Wood
- Centre for Cardiovascular and Heart Valve Innovation, University of British Columbia, Vancouver, British Columbia, Canada
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